Predictors and Outcome of Conversion to Cardiac Surgery During Transcatheter Aortic Valve Implantation
Transcatheter aortic valve replacement (TAVR) periprocedural complications rate are low; however, those patients requiring conversion to surgery are under an increased mortality risk. Arsalan and colleagues evaluated 32 patients, 2.1% of 1775 total TAVR procedures at their center, who needed immediate conversion to sternotomy during the TAVR procedure. The most common reasons for conversion were annular rupture, device embolization, and pericardial tamponade. The only predictor for conversion was the usage of a self-expandable valve (OR 0.38, 95% CI 0.16 – 0.90, p = 0.03). Survival at 30 days was 56%, emphasizing the importance of an experienced heart team and access to emergency surgical procedures for these uncommon but unpredictable situations.
Interesting to see that scores of salvage post-failed TAVI conventional aortic valve replacements did badly. I wonder what would be the outcome for these patients if they were offered planned (elective) conventional replacement in the first place.
The answer is it depends on the cohort you are dealing with. We were one of the early adopters of TAVR in 2010. Our first 30 patients were Cohart A whose STS and Euroscore M&M were prohibitive . The problem now is that we perform TAVR on intermediate risk pts whose operative mortality is approximately 4% which mandates an almost perfect result when you compare it with SAVR. One point in closing, the morbidity and recovery are very different particularly in octegenatians…